How does the operation of PHARMAC's 'Community Exceptional ...

Other results showed that 81% of the doctors in the study withheld some
services from patients because they believed there would be minimal benefit
from the proposed treatment. One reason which was given for withholding
treatment was that the quality of life provided by the treatment would be low.
Another reason the doctors in the study gave for withholding treatment was that
the patient was over 85 years of age. Both of these factors which influenced
the doctors’ decision making were essentially moral considerations involving the
doctors’ beliefs about what constitutes an adequate quality of life and beliefs
about withholding treatment from the ‘old-old’ (people over 80 years of age).
These are not clinical decisions but contain significant ethical and moral
content, at the least, worthy of discussion with the patients or their families.
Age has been a factor in the selection of patients for organ transplantation
(Hoffenberg, 1994). The ethical considerations related to organs for
transplantation that have been retrieved from the dead were discussed by
Hoffenberg (1994) during the Biko Lecture of 1994. He described the unstated
rule in South Africa that young patients, and patients over 55, were not
considered suitable candidates for transplantation. He believed that there were
some plausible clinical reasons why these candidates should be excluded, but
essentially this form of micro-level rationing was an ethical consideration. The
thinking behind this judgement by doctors assessing a patient for
transplantation, was that a chance of life or better health should be given to
those who could still enjoy a fruitful and productive life, or as Hoffenberg (1994)
more crudely put it people who were not “past it”.
Such considerations may perhaps be forced on medical practitioners because
there is scarcity of resources (in Hoffenberg’s case a scarcity of organs for
transplantation). However the frequency of rationing in the Hurst et al (2006)
study was correlated with the perceived scarcity of resources and significant
differences between the countries were found. One might postulate that the
countries with the greatest resources would place less pressure on the interns
to ration, however the study showed that the doctors in Switzerland with the
highest health spending per capital of countries in the study, rationed the most
(Hurst, et al., 2006). Italy, the country with the most doctors per capita, rationed
the least.
45